Beginning January 15, 2022, the Plan is required to cover FDA approved at home COVID-19 tests with no cost-sharing*.
The Biden administration released guidance mandating group health care plans and insurers to provide coverage of over the counter, FDA approved at home COVID-19 tests. According to this guidance, FDA approved at home COVID-19 tests are to be covered with no member cost-share effective January 15, 2022. At home tests obtained prior to January 15, 2022, are not subject for reimbursement under this mandate.
*If obtained at an out-of-network pharmacy, reimbursement is the actual price paid or $12 per test, whichever is less.
Here is what you need to know:
- This is applicable to all eligible active members, their covered dependent(s) & non-Medicare eligible retirees and their covered dependent(s)
- This is not applicable to Medicare- eligible retirees with coverage under the RWP Medicare PDP or any other Medicare Part D Prescription Drug Program (If you have Medicare, please refer to the bottom of this page for some important information)
- There is no coverage under Medical for the FDA approved at home COVID-19 tests as outlined under this mandate
- This mandate does not include employer mandated tests for employment purposes
- There is a quantity limit of 8 tests, per covered member/dependent(s), per Calendar Month
- There is no cost-sharing for the member
- The cost of the at home test does not apply to the member’s deductible or out-of-pocket costs
- You do not need a prescription to obtain an at home test
- Most at-home COVID-19 test kits authorized by the FDA are covered. Look for an FDA Emergency Use Authorization label on the package.
- The most common tests are BD Veritor™, CareStart™, Celltrion DiaTrust™ COVID-19 Ag Rapid Test, Flowflex™, i-Health®, INDICAID™, InteliSwab™, MaximBio ClearDetect™ COVID-19, On/Go™, or Pilot™ COVID-19 AT-Home test kits (Roche).
- There is absolutely no reimbursement allowed under the Family Supplemental Benefit.
There are two options to obtain an FDA approved at home COVID-19 test. Please choose whichever one is applicable to you:
Option 1- Obtain through a network pharmacy:
- You must present your MOE Vendor card to the network pharmacy staff. If billed correctly, there will be no out of pocket cost to you
- Currently, the network consists of Walgreens (including Duane Reade), Walmart Pharmacy, Sam’s Club, Rite Aid (including Bartell Drugs) & Kinney Drugs. Please note that the general Prescription Drug Program network has not changed. The pharmacy network listed is only applicable to obtaining an FDA approved at home COVID-19 test.
Option 2- Direct Member Reimbursement (DMR):
- If you are unable to utilize a Walgreens, Walmart Pharmacy, Sam’s Club, Rite Aid or Kinney Drugs, you can purchase an at home kit at an out-of-network pharmacy and submit your receipts for reimbursement through OptumRx
- For this option you would pay out of pocket for your test and submit a reimbursement request. Per current guidance, reimbursement is the actual price paid or $12 per test, whichever is less.
- You have two options for submitting your reimbursement request:
Electronically:
- You can input your information electronically here. You must upload your original register receipt for your request to be submitted.
- Unfortunately, we are unable to give a turnaround time for receiving your reimbursement.
Manually:
- To request your reimbursement manually, you can complete the DMR form (DMR form linked here)
- You must include your original receipt with your completed form and mail them to:
- OptumRx Claims Department, PO Box 650334, Dallas, TX 75265-0334
- Reimbursements must be sent to the OptumRx address above. Please do not send them to the Fund Office, they will be returned to you.
- You will receive your reimbursement through the mail. Unfortunately, we are unable to give a turnaround time for receiving your reimbursement.
If you have any questions, please refer to the OptumRx FAQ’s or you can contact the Pharmacy Benefit Department at 708-387-8331.
At-home COVID-19 tests and Medicare
The United States Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. Visit https://www.hrsa.gov/coronavirus/testing-supplies for more information.
On April 4, 2022, the Biden-Harris Administration announced that Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, now have access to FDA approved, authorized, or cleared over the counter COVID-19 tests at no cost.
Here is what you need to know:
- Beginning April 4, 2022, Medicare Part B will cover up to 8 authorized or cleared over the counter at-home COVID-19 tests per month from participating pharmacies and health care providers at no cost for the duration of the COVID-19 public health emergency.
- You must present your red, white and blue Medicare card
- The quantity limit of 8 tests per patient per calendar month applies only to the OTC COVID-19 tests and doesn’t apply for laboratory-performed COVID-19 tests and other COVID-19-related services.
- National pharmacy chains are participating in this initiative, including: Albertsons Companies, Inc., Costco Pharmacy, CVS, Food Lion, Giant Food, The Giant Company, Hannaford Pharmacies, H-E-B Pharmacy, Hy-Vee Pharmacy, Kroger Family of Pharmacies, Rite Aid Corp., Shop & Stop, Walgreens, and Walmart.
- A list of eligible pharmacies and other health care providers that have committed publicly to participate in this initiative can be found at https://www.medicare.gov/medicare-coronavirus#300. Because additional eligible pharmacies and health care providers may also participate, people with Medicare should check with their pharmacy or health care provider to find out whether they are participating.
- Medicare is not requiring participating eligible pharmacies and health care providers go through any new Medicare enrollment processes. If a health care provider currently provides ambulatory health care services such as vaccines, lab tests, or other clinic type visits to people with Medicare, then they are eligible to participate in this initiative.
The initiative adds to existing options for people with Medicare to access COVID-19 testing, including:
- Access to no-cost COVID-19 tests through health care providers at over 20,000 testing sites nationwide. A list of community-based testing sites can be found here.
- Access to lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost through Medicare.
- In addition to accessing a COVID-19 laboratory test ordered by a health care professional, people with Medicare can also access one lab-performed test without an order and cost-sharing during the public health emergency.
If you have any questions regarding Medicare coverage of at-home COVID-19 tests, please contact Medicare at 1-800-MEDICARE (1-800-633-4227).